Cytotechnologist Education, Schools, and Career Overview

In the 1920s, Greek physician and anatomist, Dr. George Nicholas Papanicolaou was the first to develop the “Papanicolaou Smear,” now commonly called the “Pap Smear” or “Pap Test.” The pap test is collected during an annual gynecological exam. Pap tests are a critical prescreening test for cervical cancer and women are typically urged to have these tests done annually in order to prevent and detect cervical cancer and other infectious diseases. Cytotechnologists interpret pap tests by examining the slide under a microscope to determine if there are abnormalities.

Interpreting pap tests is only one example of what a cytotechnologist does. Cytotechnologists interpret cells from all body sites. Cells are aspirated, scraped or collected, then processed to produce a slide. The slide is then viewed under a microscope and checked to determine whether or not the cellular changes are inflammatory, pre-cancerous or cancerous lesions.

Cytotechnologist Duties and Specializations

Cytotechs mainly use microscopes and computers to analyze slides. There are typically two different types of microscopes used; a traditional manual scope where the cytotech controls the settings, and a microscope tied to an imaging system. Essentially the later type of microscope helps guide the cytotech to areas of interest on the slide where an abnormality maybe present.

Fine Needle Aspiration (FNA) biopsies are another common procedure that warrants the assistance of a cytotechnologist. In the hospital setting, Fine Needle Aspiration (FNA) biopsies are a common procedure that warrant the assistance of a cytotechnologist. FNAs involve a physician placing a very thin needle inside a mass or tumor to extract cells to be examined under a microscope. After the physician extracts the cells, the cytotech then puts the material on a slide, does a rapid stain and provides the physician with an adequacy check. The rest of the material is then taken back to the lab for further processing, and screening to determine whether or not there is atypia or malignant cells present. This interpretation of the slide is critical because it aids in diagnosing the patient and determining what type if any follow-up procedure is needed.

Cytotechs mainly work with pathologists, which are doctors who use laboratory medicine to treat and diagnose patient illnesses. Cytotechnologists typically sign out their own negative or benign cases. If they see anything of concern or are uncertain, they flag those slides for the pathologist’s review and opinion.

In addition to the pathologist, cytotechs also oftentimes work with histotechnologists, who are trained to prepare tissue for examination by the pathologists. They also provide immunology stains for review by the cytotechnologist and pathologist.

Cytotechs may also work with clinical lab scientists, commonly called medical technologists, who handle the lab’s molecular testing. Sometimes when a doctor sends in a pap smear they also want a Genital Human Papillomavirus (HPV) test run on those cells. Also, if it has been determined that a women has breast cancer, molecular studies can be done by the cytotechnologist and pathologist to determine if the patient will respond to a particular type of chemotherapy.

Some cytotechnologists also work with surgeons, interventional radiologists, gastroenterologists, and pulmonologists.

How to Become a Cytotechnologist

To practice as a cytotechnologist one must earn their bachelor’s degree in cytology or a science-based field. There are certain prerequisites required to be accepted into a cytology program, such as biology, chemistry, microbiology, anatomy and physiology. Often these prerequisites are taken over the first two years of college so that the last two years are focused specifically on cytology.

Here’s a quick snapshot of what you can expect, followed by additional information about educational options for cytotechnologists:

1. Interview or job shadow cytotechs who work in a variety of settings to learn more about this job/field first hand and see what type of a setting you’d prefer.

2. Enroll in a cytology bachelor’s degree program.

3. Sit for the American Society for Clinical Pathologists certification exam to earn the CT-ASCP.

4. Apply and test for state licensure.

5. Look for a job.

6. Take the annual proficiency exam.

7. Maintain the necessary continuing education units your state licensure requires (typically 24 hours within a two year period).

Cytotechnologist degree programs

To practice as a cytotechnologist one must earn their bachelor’s degree in cytology or a science-based field. There are certain prerequisites required to be accepted into a cytology program, such as biology, chemistry, microbiology, anatomy and physiology. Often these prerequisites are taken over the first two years of college so that the last two years are focused specifically on cytology.

Cytotechnologist training

Cytology programs include clinical rotations for students to gain practical experience and knowledge. Typically cytology programs include nine months of didactic course work and three months of clinical rotations. Each clinical rotation typically lasts for 2-3 weeks and is generally located in a variety of settings such as private labs and hospitals. Cytology students are mentored by seasoned cytologists who review their slides and help them refine their speed and accuracy. The clinical rotations help students decide which type of a setting they prefer to work in when they have completed their education.

Cytotechnologist schools

Since cytotechnologists must earn a bachelor’s degree, there are a variety of school options including state universities, private colleges, and technical schools. Online cytology degrees may be available as well.

Cytotechnologist license and certification

Cytotechnologists are required to pass a certification exam administered through the American Society for Clinical Pathologists (ASCP) in order to practice in this field. This computerized, multiple-choice exam is taken following graduation from a cytology program. After passing this exam, the CT (ASCP) credentials are typically awarded.

Upon passing the ASCP certification exam, there are a handful of states that also require state licensure to practice. These states include: California, Nevada, Florida, New York, Hawaii, Rhode Island, Louisiana, Tennessee, Montana, and West Virginia. To obtain licensure, a person must submit their transcripts and fees and successfully pass another exam specific to the scope of practice for that state. Most states require licensure renewal every two years. In order to renew, typically 24 continuing medical education credits must be obtained in the two-year renewal period. Although some states do not require licensure for this field, employment settings may require continuing education units to be obtained. For instance, Quest Laboratories is a national cytology lab chain that requires its employees to earn continuing education credits regardless of the state they work in. Some hospital settings also require continuing education units.

In addition to the national certification and state licensure, cytotechs are also required to pass an annual proficiency exam due to the extremely high amount of regulation in this field. This exam is typically administered through the College of American Pathologists (CAP) Proficiency testing program. The exam is required in every state that provides pap test screening services, regardless of the setting.

Career advancement for cytotechs

One of the main drawing points to this profession is the standard daytime 9-5 schedule, which can't be enjoyed in many other fields of healthcare. For cytotechs who want to advance, there is typically opportunity available. One example is the position of a quality control (QC) cytotechnologist who double-checks the work of other cytotechs. Others move up to become the laboratory supervisor or manager. In these positions more paperwork is involved, and a lot of time is spent time handling regulatory responsibilities and gathering statistical data, rather than screening slides.

Typically in order to advance, experience in the field is the key factor. However, to move up to a position such as a lab manager, most employers require a master's degree in business or public health.

Skills and Qualities for Cytotechnologists

In the field of cytology there is no black and white; rather everything is gray. One cytotechnologist may review a slide and think they see something atypical and another may review it and find it to be “normal”. Cytologists must have strong communication skills so they’re able to discuss cases with the pathologist or other cytotechs, and express their opinion as to whether they view a slide as normal or atypical.

Cytotechs must also have a very precise attention to detail and handle each slide they review with care, giving it the attention it needs. Cytotechs spend the bulk of their day reviewing slides, unless in the hospital setting where they may be required to handle Fine Needle Aspirations, so they must be okay in a sedentary job.

Career Outlook and Salary Information

It can be hard to pinpoint specific salaries for cytotechnologists since the U.S. Bureau of Labor Statistics (BLS) groups them in with medical and clinical laboratory technologists and technicians. And as with any position, pay can vary by region and experience. Here's a snapshot of salary data for cytotechnologists: